DURHAM REGION HEALTH DEPARTMENT. Feeding Your Baby Formula

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1 DURHAM REGION HEALTH DEPARTMENT Feeding Your Baby Formula

2 What s Inside Choosing an Infant Formula... 3 Amount of Formula Babies Need... 5 Preparing Infant Formula... 6 Choosing the Right Water...6 Types of Water You Should Not Use...6 Types of Water to Use When Mixing Formula...7 Sterilization...8 Bottles...8 Nipples...8 Storage & Heating...9 Feeding Tips Breastfeeding is recommended as the optimal method of feeding infants and may continue for up to two years and beyond. If a baby is not breastfed, or is partially breastfed, commercial infant formulas are the most acceptable alternative until nine to twelve months of age. The information in this book is intended for healthy full term babies. For more information about feeding premature, low birthweight or ill babies, talk to your doctor. 2 Feeding Your Baby Formula

3 Choosing an Infant Formula When you choose to formula feed your baby, commercial infant formula is all your baby needs for the first 6 months. The formula has all the vitamins and minerals needed. No supplements are required. To reduce the risk of iron deficiency, the Canadian Paediatric Society and Dietitians of Canada recommend an iron-fortified formula be used from birth. Some health care providers and parents think iron-fortified formulas can upset a baby s digestive system. Studies have shown that babies fed iron-fortified formula do not have more problems with constipation, gas or fussiness. Use an iron-fortified formula until your baby is 9-12 months old and eating a variety of solid food. For families where there is no history of allergies, the standard formula is one made from cow s milk. Infant formulas made from cow s milk are well digested by most babies. If you think your baby needs a different type of formula, talk to your doctor or a dietitian. Feeding Your Baby Formula 3

4 Follow-Up formulas are designed as an alternative to cow s milk for babies six months and older. Babies do not need a Follow-Up formula. If you decide to use one of these formulas, wait until your baby is at least six months old. The amounts and forms of some of the nutrients do not meet the needs of babies under six months. Some formulas have added fatty acids that might be labelled Omega-3, DHA or ARA. They often cost more than other formulas. There is no known health advantage when compared to standard formulas. Home-made, canned evaporated whole milk formula should not be used in place of commercial infant formula. This type of milk does not have the right amount and type of nutrients that a baby needs. Once you choose a formula, try to keep your baby on it. Switching formulas too often can cause stomach upset and changes in your baby s bowel habits. If you feel that you need to change formulas talk to your doctor first. When you try a new formula, keep your baby on it for at least a week. By then you will know if he can tolerate it. For more information about choosing an infant formula, talk to your doctor, dietitian or public health nurse. 4 Feeding Your Baby Formula

5 Amount of Formula Babies Need The amount of formula your baby eats may change from day to day. Below is a chart showing the approximate number of feedings and amount of formula the average baby will take in a day. Do not worry if your baby eats less than or more than the amounts listed. The most important sign that your baby is eating the right amount of formula is that he is growing well. If you are worried about your baby s growth, talk to your doctor. Babies grow faster at three weeks, six weeks and three months. During these times you may need to feed more often. Offer more formula not solid food. Age Number of feedings per day Amount of formula in each bottle Birth 6-10 Birth to Day 3 Baby will need frequent feedings ½ to 2 oz. at each feeding then larger amounts each day 2 weeks oz. ( ml) 1 month oz. ( ml) 2 months oz. ( ml) 3 months oz. ( ml) 4 months oz. ( ml) 5 months oz. ( ml) 6 months oz. ( ml) 7 months oz. ( ml) 8 months oz. ( ml) 9 months oz. ( ml) 10 months oz. ( ml) 11 months oz. ( ml) 12 month oz. ( ml) Feeding Your Baby Formula 5

6 Preparing Infant Formula Infant formulas are sold in three forms: ready-to-feed, concentrated liquid and concentrated powder. They all contain the same nutrition. The ready-to-feed formulas are more convenient, but they usually cost more than the concentrated liquid and powder forms. Powdered formula is not sterile. Infants who are premature, low birthweight or ill are at the highest risk of getting sick from non-sterile powdered formula. These babies should drink sterile liquid formula. For more information about using and preparing powdered infant formula, talk to your doctor, dietitian or public health nurse. When mixing formula, follow the instructions on the label. Use the right amount of formula and water. Do not dilute the formula by adding extra water. Using too much or not enough formula can harm your baby. Choosing the Right Water See the chart on the next page for the types of water that are safe to use when mixing formula. Types of Water You Should Not Use Bottled and filtered water may have minerals in amounts that are not safe for your baby. Terms like distilled, reverse osmosis and softened may indicate that the mineral content is too high or too low. Do not use carbonated or mineral water. Never use water directly from untreated sources, such as springs, rivers, and lakes to make baby formula. 6 Feeding Your Baby Formula

7 Types of Water to Use When Mixing Formula Water Recommendation Municipal (Tap) Water Good quality. Safe to use unless the Health Department says it is unsafe. Use cold tap water only. Run water for at least five minutes or until cold each morning before making formula. This will flush out any metal buildup such as lead and copper. Well Water Test for bacteria and nitrate levels. May have naturally high levels of nitrates and other heavy metals. Testing for nitrates and other chemicals can be done through a private lab. For a list of labs see Ministry of Environment website at ene.gov.on.ca Have well water tested at least three times per year for bacteria levels. To learn how to have your well water tested, call the Durham Region Health Department Environmental Help Line at or or visit our website at durham.ca Water from Home Water Treatment Systems & Devices Call the manufacturer or Health Canada for information on the safety of this water to make baby formula. Bottled Spring Water Bottled spring water can be used if tap water is not available or it is not safe. Look for a product with the lowest sodium (Na) and nitrate (NO3) content. If you are not sure which water to use call the Durham Region Environmental Help Line at Feeding Your Baby Formula 7

8 Sterilization For the first four months, sterilize all bottles and nipples by boiling them for five minutes. Use sterilized tongs to put caps, rims and nipples on bottles. The dishwasher and microwave should not be used for sterilization. All types of water must be boiled before using it to make formula. Bring water to a rolling boil for at least two minutes. Boiled water can be stored for two to three days in the refrigerator in a sterilized container with lid. Sterilized water will also keep at room temperature for 24 hours in a sterile, closed container. Bottles Glass bottles are easy to clean, dry fast and keep the formula warmer than bottles with plastic liners. Since they hold their shape, they are a reliable measuring tool. Formula can be mixed directly in the bottle. Disposable plastic bottle liners are more convenient since only the nipples and rings need to be sterilized. The bags do not provide an accurate measure. Measure formula in a proper measuring cup. Throw away bags after each use. 8 Feeding Your Baby Formula

9 Nipples Nipples should be comfortable in the baby s mouth. The only difference between a nipple with a circular hole and a nipple with a cross cut hole is the shape. The most important thing to watch for is that the formula comes out in steady drops at a rate the baby can manage. If the nipple hole is too big, baby will take in air. Hold the bottle upside down. The formula should flow out at a rate of approximately one drop per second. The formula should not come out in a constant stream. Storage & Heating Refrigerate prepared bottles immediately. Use within 24 to 48 hours, depending on the manufacturer s instructions. Cover cans of powdered formula with plastic top and store in a cool dark place. Use within one month. Cans of ready-to-use formula should be covered and refrigerated. Use within 24 to 48 hours depending on the manufacturer s instructions. To warm a bottle, run the bottle under warm running water or heat the bottle in a pan of hot water. Do not leave the pan on the stove while heating the bottle. Heating formula in the microwave is not recommended. Microwaves do not heat evenly. Liquids continue to heat after being removed from the oven which can result in hot spots. The bottle may feel warm on the outside, but the hot spots may burn the baby while eating. Always test the temperature of the formula on your wrists before giving it to a baby. At the end of a feeding, throw away any formula left in the bottle. Do no use formula more than one hour after the start of a feeding. Feeding Your Baby Formula 9

10 Feeding Tips Let your baby be the guide of when to feed. Make sure your baby does not get too hungry. A baby eats best when awake and alert not crying and upset. Signs that a baby is hungry include: waking up, rapid eye movement, stretching, sucking on hands, moving his lips, opening mouth and turning toward you when you touch the mouth, cheek or chin. Find a comfortable place to feed your baby. Hold your baby close while you feed him. Babies like skin to skin contact. Give him enough room to wiggle, but hold him tight enough so he feels secure. Look at your baby. Babies like some eye contact during feeding. Support the baby s head. Make sure it is higher than the rest of his body. A baby should be in a semi-sitting position during and after a feeding. Wait for baby to open his mouth for the bottle. Hold the bottle at an angle so that the nipple is full of milk while the baby drinks. During feeding your baby may take a break from eating. If your baby stops eating and is fussy, soothe him. Offer the bottle again when he settles down. Do not try to force the baby to take more if he does not seem interested. 10 Feeding Your Baby Formula

11 Burp your baby after every feeding. You can try burping him during the feeding if he stops eating and seems uncomfortable. Stop feeding when baby shows signs of being full. A baby who has had enough to eat will usually turn his head away and push the nipple out of his mouth. Other signs that he may be full are: sucking more slowly, closing his lips when the bottle comes near his mouth, and becoming interested in other things around him. If baby falls asleep while drinking, keep him upright on your shoulder or chest for about five to ten minutes. At the end of a feeding throw away any formula left in the bottle. Never prop a baby with a bottle. A baby can t push the bottle away, which can lead to choking. Feed baby cereal with a dish and spoon. Do not add cereal to the bottle. Babies should not be put to bed with a bottle. A baby could choke as well as be at risk of developing Early Childhood Tooth Decay, or, Nursing Bottle Syndrome which is a severe form of tooth decay seen in infants and toddlers. For more information contact Durham Region Health Department, Oral Health Division at A commercial infant formula prepared and stored properly can provide all the nutrition a baby needs for the first six months of his life. NB The use of him/he includes she/her. Feeding Your Baby Formula 11

12 DURHAM REGION HEALTH DEPARTMENT Durham Health Connection Line or durham.ca If you require this information in an accessible format, contact Feb. 2016

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